Fifteen years ago, when I was a psychology intern at a juvenile hall facility, I met with a 15-year old boy who was a member of gang – a “tagger,” to be more specific. His tagging activities had gotten him into trouble more than once, and this time, the reason he ended up in juvenile hall was because he was caught in the act of tagging a police car. Unless his goal was to end up in juvenile hall (and, after getting to know him, it certainly might have been), this was clearly not a smart move.
I’ll never forget this young man. For one thing, he was an incredibly talented artist. If he could have channeled his creative and artistic ability into something more socially acceptable (or if he could have emulated Jean-Michel Basquiat or Keith Haring), he could have made a successful art career for himself. Which is exactly what I said to him. His response?
“I don’t tag because I’m good at it. I do it because it makes my head shut up.”
Hmm. After a series of questions (and clarifying that he wasn’t hearing schizophrenia-style voices), it became clear that he was experiencing high levels of anxiety.
“Do you know what it is that makes you so anxious?” I asked him.
“Yeah,” he said. “I’m afraid I’m going to turn gay.”
This was a kid who was in a gang. So was his dad, his brothers, his cousins, and pretty much every male in his family. If he really was gay, his family (and the gang) probably wouldn’t take it well, to say the least. Frankly, I wasn’t convinced that he actually was gay. To me, it seemed like he had some form of obsessive-compulsive disorder, his obsessions focusing on the possibility of turning gay, and his compulsions being, among other things, the tagging behavior. So I shared this case with my supervisor and offered my very novice-level opinion. “What do you think?” I asked.
He shook his head. “He’s gay,” he said definitively. “And the fact that he’s gay is causing him a tremendous amount of anxiety. He’s going to have to come to terms with it at some point.”
Now, if you are a regular reader of this blog, you know that I am all about getting okay with your sexual identity. In fact, therapists who try to convince their clients that they’re not really gay, or that they could be straight (or at least act straight) if they were motivated enough to do so, make me totally sick. “There oughta be a law” was the title of my blog post several months ago about SB 1172, the first piece of state legislation prohibiting mental health practitioners from engaging in sexual orientation change efforts with patients under the age of 18. Personally, I think this is a very good law, because dragging your LGBTQ kid into therapy to try to make them straight will undoubtedly cause them irreparable damage. But what about a (probably straight) teenage boy whose therapist tries to convince him that he’s gay – and that he should be okay with it? That scenario goes way outside the “Psychotherapy 101” training manual.
Fast-forward to 2013. Last week, I had a conversation with someone that, in hindsight, was eerily familiar – kind of like deja-vu. He asked me, “Have you ever heard of HOCD?”
I had never heard of HOCD. So his next question was:
“Well, then, I’m sure you heard of OCD?”
Obsessive-compulsive disorder. Yes, I’m quite familiar with it. I had a feeling I knew where this was going.
“The ‘H’ is for ‘homosexual.’ I have a fear that I might become gay, even though I know I’m straight.” He paused. “I’m not homophobic, and I support gay rights fully. But I have all this anxiety about one day being attracted to men instead of women.”
HOCD is not a scientific term, nor is it a DSM-diagnosable disorder. Rather, it’s a name the OCD community has come up with to identify this phenomenon. A 2010 article in Time magazine addressed the issue of HOCD (also sometimes referred to as SO-OCD, “SO” being short for “sexual orientation”). Monnica Williams, a clinical psychologist and researcher at the University of Louisville, has conducted some research on the prevalence of HOCD and has written an informational article about it, which includes a diagnostic differentiation between HOCD and true homosexuality. But other than that, very little information exists about this disorder. And not having information about it could potentially be dangerous.
Dangerous? How so? Consider the following case example that Monnica Williams provides in her article:
I had a really bad experience. I have been diagnosed with OCD for a while now. The therapist I was seeing told me that I should try to be with a man, and that everybody is bisexual. It really freaked me out, and I was suicidal for five months thanks to what she said. The thoughts grew even stronger. Eventually, I couldn’t be with any person of the same sex alone in the same room, watch TV, read the newspaper, or listen to music with male voices. I’m amazed that I’m still in this world after that experience. Therapists should be aware of what they are telling people like us (Williams, 2008, p. 200).
Of course, reinforcing homophobia and sexual prejudice is not an acceptable therapeutic practice – and Williams makes clear in her writing that people with HOCD are not necessarily, by definition, homophobic. Rather, the point she makes is that trying to convince someone who’s straight that they’re really not, or that they could be gay, is just as damaging as subjecting an LGBTQ person to sexual- or gender-reparative therapy. But I think therapists who work with HOCD clients have to walk a fine line – affirming their clients’ true sexual orientation and help reduce their anxiety, but to do so without reinforcing any internalized homophobia.
I’m actually surprised that more hasn’t been written about this disorder. And in some ways, I understand why – a lot more energy has focused on preventing reparative therapy against LGBTQ individuals. But it seems to me that a ban on “sexual orientation change efforts” should apply across the board – and that any therapy that affirms one’s existing sexual orientation, wherever the person might be on the spectrum, is a healthy thing.
The conversation I had last week ended with me asking the following question: “Have you seen a therapist for this?”
“No,” he said quickly. “I’m afraid they’ll try to convince me I’m gay.”